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Aarya Eye Care

Retina & Uveitis

OVERVIEW OF RETINA AND UVEA
What is the retina?

Retina is the innermost of the 3 coats of the eye. This layer converts light that enters in to your eye in to electrical signals.

Common diseases affecting the Retina:
  • Diabetic retinopathy
  • Hypertensive retinopathy
  • Retinal detatchment and holes
  • Age related macular degenerations
  • Epiretinal membrane
  • Macular holes
  • Retinitis pigmentosa
  • Retinal vein occlusions
  • Retinopathy of Prematurity

Diabetes and eye – an overview

Diabetic retinopathy with exudation and haemorrhages

Who is at risk?

Get a dilated eye exam— “If you have diabetes, be sure to have a comprehensive dilated eye exam at least once a year. Diabetic eye disease can be detected early and treated before noticeable vision loss occur”

Have diabetes? You are at risk— Anyone with diabetes is at risk of getting diabetic retinopathy. The longer someone has diabetes, the more likely he or she will get this eye disease. In fact, between 40 and 45 percent of those with diagnosed diabetes have some degree of diabetic retinopathy.

Women with diabetes who become pregnant — or women who develop gestational diabetes — are at high risk for getting diabetic retinopathy

How diabetes affects the eye?

Diabetes damages blood vessels all over the body. The damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well. These new blood vessels can leak or bleed easily.
Diabetes can also make you more likely to develop several other eye conditions:

Having diabetes makes you 2 to 5 times more likely to develop cataracts. It also makes you more likely to get them at a younger age.

Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma.

Comprehensive eye examination for diabetic retinopathy screening includes visual acuity, measurement of intraocular pressure, slit lamp examination of the anterior segment and dilated fundus examination by indirect ophthalmoscopy and slit lamp bio microscopy by trained ophthalmologists and retinal images captured for records. OCT scan of retina may be advised as needed.

The gold standard for grading the severity of diabetic retinopathy is stereoscopic fundus photography through dilated pupils

OCTA has been developed to image the retinal microvasculature, by generating 3-dimensional images based on the motion contrast of circulating blood cells.
OCTA offers numerous benefits over traditional fluorescein angiography in visualizing the retinal vasculature in that it is non-invasive and safer; while its depth-resolved ability makes it possible to visualize the finer capillaries of the retinal capillary plexuses and choriocapillaris.

OCTA can detect diabetic retinopathy even before it is clinically detectable on fundus examination

What can I do to prevent diabetic retinopathy?

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels in a healthy range. You can do this by getting regular physical activity, eating healthy, and carefully following your doctor’s instructions for insulin or other diabetes medicines.

Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So, controlling your blood pressure and cholesterol can also help lower your risk for vision loss.

Screening:

TYPE OF DIABETES FIRST RETINAL EXAMINATION FOLLOW UP
TYPE 1
3-5 years after diagnosis
At least yearly
TYPE 2
At the time of diagnosis At least yearly
BEFORE PREGNANCY
Before conception and early in the first trimester of pregnancy Monitoring Every Trimester And 6 Weeks after delivery
Abnormal findings may dictate more frequent follow up examinations.

What’s the treatment for diabetic retinopathy and DME?

In the early stages of diabetic retinopathy, your eye doctor will just keep track of how your eyes are doing.
It’s also important to take steps to control your diabetes, blood pressure, and cholesterol.
Some people with diabetic retinopathy may need a dilated eye exam as often as every 2 to 4 months.
In later stages, it’s important to start treatment right away.

Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also used.

To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.

If your retina is bleeding a lot or if you have a lot of scars in your eye, your eye doctor may recommend a type of surgery called a vitrectomy.

Take home message:

Get a dilated eye exam at least once a year. It’s the best way to catch vision problems early, when they’re easier to treat.

Take these steps to manage your diabetes — and keep your eyes healthy:

  • Check your blood sugar levels regularly at least once a month. Get FBS,PPBS done once in a month and HbA1c 6 monthly
  • Get active. Start any form of aerobic exercises (walking, yoga)
  • maintain a low carb diet
  • Quit smoking and drinking alcohol
  • Dilated eye check-up once in a year (if you have diabetic retinopathy, check up may be needed as frequently as 3 monthly as per your eye doctor’s advice)

Our comprehensive Diabetic Retinopathy check up includes:

  • Vision
  • Refraction
  • Dilated examination
  • OCT Macula
  • GRBS
  • BP
  • Doctor consultation

Macula, the central portion of retina plays a vital role in vision. In ARMD, macula starts to degenerate, leading to impaired vision. It is quite common after 65 years of age.
Treatment for ARMD may prevent or slow down vision loss, but might not restore lost vision.

Treatment plans includes: Anti VEGF injections, Laser therapy, Low vision aids.

ROP is a potentially blinding disease which can occur in premature or low birth weight babies. ROP occurs when abnormal blood vessels grow in the immature retina of premature babies.

Which infants need to be screened for ROP?

  • Premature babies born at 34 weeks or less
  • Birth weight of 2000gm or less
  • Other preterm infants exposed to risk factors like oxygen therapy in NICU at the discretion of neonatologist.

Treatment

Most babies with early stages of ROP recover without treatment. Advanced stages may require treatment like laser, injections or surgery.

Uvea is the middle layer of the eyewall. Inflammation of this layer is called as uveitis.

Symptoms:

  • Red eye with or without pain
  • Sensitivity to bright light
  • Blurry vision
  • Seeing floaters all of a sudden

Diagnosis and Treatment

A Comprehensive eye exam is required to categorise the type of uveitis along with a whole battery of tests like blood tests, x-rays, CT scan
Uveitis requires immediate treatment to prevent vision loss. It is treated with eyedrops,oral medications,injections. In severe cases, surgery may be required.
As it is associated with other systemic illness rheumatologist reference is required.